The use of
pulsed dye laser energy for angioplasty offers the possibility of ablating
atherosclerotic plaques without thermal damage to the adjacent arterial wall. However, to be of value, systems that deliver the energy safely and effectively are required. We tested multifiber
catheters in 504-nm
pulsed dye laser angioplasty for treatment of peripheral
arterial occlusions. Flexible multifiber
catheters consist of 12 (7-French) and 19 (9-French) concentrically arranged 200-microns
quartz fibers allowing guidewire-directed use. Laser-assisted angioplasty was performed in 2- to 13-cm- (mean, 7.5-cm) long occlusions of iliac (six) and femoropopliteal (23) arteries in patients with symptomatic occlusive
vascular disease. Angiograms were obtained before and after
laser ablation, after subsequent balloon dilatation, and if signs or symptoms indicated restenosis, during follow-up. The
laser procedure was impossible to perform in three (10%) of 29 patients; this was related to unsuccessful passage of the wire in one patient and to inability to advance the
laser catheter across the lesion in two patients. In one other patient, reocclusion occurred 1 day after angioplasty. Stand-alone laser angioplasty relieved residual
stenosis of less than 30% in six (26%) of 23 femoropopliteal arteries, making balloon dilatation dispensable. Immediate clinical improvement was achieved in 26 (90%) of 29 patients.
Laser treatment caused no perforation and no embolization, but minor dissections occurred in 36% of the patients. Our experience suggests that
pulsed dye laser angioplasty via multifiber
catheters converts
arterial occlusions into
stenoses. With the exception of angioplasty in distal femoropopliteal arteries, additional balloon dilatation is necessary to complete recanalization.